Cost of Form - Rs. 15/- (Fifteen ) Only Form No. Date of Issue Cut Here Cut Here Cut Here Cut Here Cut Here Cut Here F0RM The Licensing Authority ¦ >t*iiia*iim>«Miiiii«iiii<i*iiiiiiii»iiit«»HMiiini»itiv'>*iiii I /We (Name in block Letters)................................................................................................... ...................................................................... apply for grant/renewal of a Licence under the provisions of the Prevention of Food Adulteration Act, 1954 ( Central Act No. 37 of 1954) and the rules made thereunder for the manufacture for sale / for storage / for sale / for the distribution of exhibition of..................................................................................................................................... in the premises situated at................................,...............,.............................................................. Temporary estates situated at.......................................................................................................... fora period of from.................................................................To.........................,........................ ... Mt/our annual turnover is Rupees.................................................................................................... In case of renewal only. I/We shall abide by the Prevention of the Food Adulteration Act, 1954 and the rules made under may carry on the aforesaid licence granted to us. The Municipal receipt of Rs.......................... .........................................................................................dated............................................. on account of fees for on licence as per the schedule appended to the J&K Prevention of Food Adulteration, 1954 is enclosed. The Statement made above are true to the most of my / our knowledge & belief and if anything is found false or not true, the licence shall be liable to be cancelled. Signature of Applicant Foot Note :- The Applicant shall his passport size photo copies in triplicate (This applies to itinerant vendors or hawkers.)
